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Corcoran A, Shore D, Boesch RP, Chopra M, Das S, DiBardino D, Goldfarb S, Haas A, Hysinger E, Phinizy P, Vicencio A, Toth J, Piccione J. Practices and perspectives on advanced diagnostic and interventional bronchoscopy among pediatric pulmonologists in the United States. Pediatr Pulmonol 2024. [PMID: 38558404 DOI: 10.1002/ppul.26977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/18/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Advanced diagnostic bronchoscopy includes endobronchial ultrasound (EBUS) guided transbronchial lung and lymph node biopsies, CT navigation and robotic bronchoscopy. Interventional bronchoscopy refers to procedures performed for therapeutic purposes such as balloon dilation of the airway, tissue debulking, cryotherapy, removal of foreign bodies and insertion of endobronchial valves [1]. For adult patients, these procedures are standard of care [2, 3]. Despite a lack of formalized training, there are numerous case reports and case series describing the use of advanced diagnostic and interventional bronchoscopy techniques in children. The safety and feasibility of EBUS-TBNA, cryotherapy techniques, endobronchial valves among other techniques have been demonstrated in these publications [1, 4-9]. METHODS We sought to better understand the current practices and perspectives on interventional and advanced bronchoscopy among pediatric pulmonologists through surveys sent to pediatric teaching hospitals across the United States. RESULTS We received 43 responses representing 28 programs from 25 states. The highest bronchoscopy procedure volume occurred in the 0-5 years age group. Among our respondents, 31% self-identified as a pediatric interventional/advanced bronchoscopist. 79% believe that advanced and interventional training is feasible in pediatric pulmonology and 77% believe it should be offered to pediatric pulmonary fellows. DISCUSSION This is the first study to characterize current practices and perspectives regarding advanced diagnostic and interventional bronchoscopy procedures among pediatric pulmonologists in the United States. Pediatric interventional pulmonology (IP) is in its infancy and its beginnings echo those of the adult IP where only certain centers were performing these procedures.
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Affiliation(s)
- A Corcoran
- Division of Pulmonary and sleep medicine, Children's Hospital Of Philadelphia, Philadelphia, PA
| | - D Shore
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - R P Boesch
- Mayo Clinic, Children's Center, Pediatric and Adolescent Medicine, Rochester, Minnesota
| | - M Chopra
- Division of Pulmonary, The University of Arizona, Tucson, Arizona
| | - S Das
- Section of Pediatric Pulmonary Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - D DiBardino
- Division of Pulmonary, Allergy, and Critical Care Medicine Perelman School of Medicine, University of Pennsylvania Philadelphia, PA
| | - S Goldfarb
- Division of Pulmonary and Sleep Medicine, University of Minnesota, Masonic Children's Hospital, Minneapolis, Minnesota
| | - A Haas
- Division of Pulmonary, Allergy, and Critical Care Medicine Perelman School of Medicine, University of Pennsylvania Philadelphia, PA
| | - E Hysinger
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - P Phinizy
- Division of Pulmonary and sleep medicine, Children's Hospital Of Philadelphia, Philadelphia, PA
| | - A Vicencio
- Division of Pulmonary Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - J Toth
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - J Piccione
- Division of Pulmonary and sleep medicine, Children's Hospital Of Philadelphia, Philadelphia, PA
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2
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Januska MN, Kaspy K, Bozkanat KM, Vicencio AG. Pediatric interventional bronchoscopy: from early limitations to achievable opportunities. Curr Opin Pulm Med 2024; 30:107-117. [PMID: 37933635 PMCID: PMC10842060 DOI: 10.1097/mcp.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
PURPOSE OF REVIEW The rapid evolution of bronchoscopy equipment and technologies, from the introduction of the 1.1 mm flexible cryoprobe to the use of navigational and robotic bronchoscopy, has afforded unprecedented opportunities for pediatric advanced diagnostic and interventional bronchoscopy. While there is growing interest among pediatric pulmonologists to incorporate these new techniques into their practice, the current pediatric landscape is characterized by few practicing interventional bronchoscopists, scant published literature, and no formal training programs. RECENT FINDINGS While the majority of the published literature consists of case reports and small case series, the increased application of new techniques is starting to yield larger and more structured studies that will be able to provide more objective commentary on the proposed indications, safety, and efficacy of such techniques in the pediatric population. SUMMARY For many decades, progress in pediatric advanced diagnostic and interventional bronchoscopy was slow and deliberate, limited by the lack of appropriately sized equipment and experienced interventional bronchoscopists. The current opportunities afforded require equal, or perhaps even more, vigilance as pediatric pulmonologists employ new equipment and technologies and define new practices and standards of care. Importantly, this review is meant to serve as a general conspectus of pediatric advanced diagnostic and interventional bronchoscopy and not a consensus guideline for the performance of advanced or even routine bronchoscopy in the pediatric population. For technical standards of pediatric bronchoscopy, refer to existing guidelines [1,2] .
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Affiliation(s)
- Megan N Januska
- Department of Pediatrics
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kimberley Kaspy
- Division of Pediatric Respiratory Medicine, Montreal Children's Hospital, Montreal, QC, Canada
| | - Kubra M Bozkanat
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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3
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Dhochak N. Interventional Bronchoscopy in Children: The Way Forward. Indian J Pediatr 2023; 90:806-810. [PMID: 37208549 DOI: 10.1007/s12098-023-04569-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/15/2023] [Indexed: 05/21/2023]
Abstract
Bronchoscopy in children has been utilized primarily to diagnose airway anomalies and obtain bronchoalveolar lavage. Gradual development of thinner bronchoscopes and instruments has opened the gates to the world of bronchoscopic interventions in children. Endobronchial ultrasound guided mediastinal aspiration has been used in adults and children. In younger children, esophageal approach has also been used for sampling of mediastinal lymph nodes. Lung biopsies using cryoprobe have been increasingly used in children. Other bronchoscopic interventions discussed include dilatation of tracheobronchial stenosis, airway stenting, foreign body removal, hemoptysis control, re-expansion of atelectasis etc. Patient safety during the procedure is of paramount importance. Expertise and availability of equipment to handle complications is of huge significance.
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Affiliation(s)
- Nitin Dhochak
- Department of Pediatrics, All India Institute of Medical Sciences, 3rd Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India.
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Piñeiro Roncal M, García Luján R, Siesto López GM, Tejedor Ortiz MT, Miguel Poch ED. [Translated article] Use of an Endobronchial Valve for Management of a Persistent Air-leak in a Child with Necrotizing Pneumonia. Arch Bronconeumol 2022. [DOI: 10.1016/j.arbres.2021.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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5
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Schütz K, Happel CM, Keil O, Dingemann J, Carlens J, Wetzke M, Müller C, Köditz H, Griese M, Reiter K, Schweiger-Kabesch A, Backendorf A, Scharff A, Bertram H, Schwerk N. Interventional Bronchus Occlusion Using Amplatzer Devices - A Promising Treatment Option for Children with Persistent Air Leak. Klin Padiatr 2022; 234:293-300. [PMID: 34979579 DOI: 10.1055/a-1697-5624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Persistent air leak (PAL) is a severe complication of secondary spontaneous pneumothorax (SSP). Surgical interventions are usually successful when medical treatment fails, but can be associated with significant complications and loss of potentially recoverable lung parenchyma. METHODS Retrospective analysis of efficacy and safety of interventional bronchus occlusions (IBO) using Amplatzer devices (ADs) in children with PAL secondary to SSP. RESULTS Six patients (four males, 4-15 years of age) underwent IBO using ADs as treatment for PAL. Necrotizing pneumonia (NP) was the most common cause (n=4) of PAL. Three patients were previously healthy and three suffered from chronic lung disease. All patients required at least two chest tubes prior to the intervention for a duration of 15-43 days and all required oxygen or higher level of ventilatory support. In three cases, previous surgical interventions had been performed without success. All children improved after endobronchial intervention and we observed no associated complications. All chest tubes were removed within 5-25 days post IBO. In patients with PAL related to NP (n=4), occluders were removed bronchoscopically without re-occurrence of pneumothorax after a mean of 70 days (IQR: 46.5-94). CONCLUSION IBO using ADs is a safe and valuable treatment option in children with PAL independent of disease severity and underlying cause. A major advantage of this procedure is its less invasiveness compared to surgery and the parenchyma- preserving approach.
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Affiliation(s)
- Katharina Schütz
- Department of Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland.,Excellence Cluster RESIST - Resolving Infection Susceptibility, Hannover Medical School, Hannover, Deutschland
| | - Christoph M Happel
- Pediatric Cardiology and Pediatric Intensive Care, Hanover Medical Specialists, Hanover, Deutschland
| | - Oliver Keil
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Deutschland
| | - Jens Dingemann
- Department of Paediatric Surgery, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Julia Carlens
- Department of Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Martin Wetzke
- Department of Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Carsten Müller
- Department of Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Harald Köditz
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Matthias Griese
- Department of Paediatric Pneumology, Dr. von Haunersches Kinderspital, German Center for Lung Research, University of Munich, Munich, Deutschland
| | - Karl Reiter
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Deutschland
| | - Andrea Schweiger-Kabesch
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Deutschland
| | - Alexander Backendorf
- Department of Neonatology and Paediatric Intensive Care, Vestische Childrenhospital Datteln, University of Witten/Herdecke, Datteln, Deutschland
| | - AnnaZychlinsky Scharff
- Department of Paediatric Haematology and Oncology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Harald Bertram
- Department of Paediatric Pneumology, Dr. von Haunersches Kinderspital, German Center for Lung Research, University of Munich, Munich, Deutschland
| | - Nicolaus Schwerk
- Department of Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland.,BREATH (Biomedical Research in End-stage and obstructive Lung Disease Hannover), German Center for Lung Research (DZL), Hannover, Deutschland
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6
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DeLong CG, McLaughlin CJ, Kulaylat AN, Cilley RE. Development of a Standardized Program for the Collaboration of Adult and Children's Surgeons. J Surg Res 2021; 269:36-43. [PMID: 34517187 DOI: 10.1016/j.jss.2021.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Children's hospitals within larger hospitals (CH/LH) have the specific clinical advantage of easily facilitated collaboration between adult and children's surgeons. These collaborations, which we have termed hybrid surgical offerings (HSOs) are often required for disease processes requiring interventions that fall outside the customary practice of children's surgeons. Formal models to describe or evaluate these practices are lacking. METHODS HSOs within a CH/LH were identified. Principles of systems-engineering were used to develop a standardized model (Children's Hybrid Enhanced Surgical Services [CHESS]) to describe and evaluate HSOs. Face validity was established via unstructured interviews of CH leaders and HSO surgeons. Areas for improved system-wide standardization and programmatic development were identified. RESULTS HSOs were identified in collaboration with adult bariatric, minimally invasive, advanced endoscopic, endocrine, thoracic, and orthopedic trauma surgical services. The CHESS framework encompassed: 1) quality improvement metrics, 2) credentialing and oversight, 3) transitions of care, 4) pediatric family-centered care, 5) maintenance of the cycle of expertise, 6) continuing medical education, 7) scholarship. While HSOs fulfilled the majority of aforementioned programmatic domains across all six HSO-providing services, areas for improvement included maintaining a cycle of expertise (33%), quality improvement metrics (50%), and pediatric family-centered care (66%). Additional noted advantages included faster translation of adult innovation to pediatric care and facilitation of emergency interdisciplinary care. CONCLUSION Formal evaluation of HSOs is necessary to standardize and improve the quality of children's surgical care. Development of a structured framework such as CHESS addresses gaps in quality oversight and provides a basis for performance improvement, patient safety, and programmatic development.
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Kagan S, Nahum E, Kaplan E, Kadmon G, Gendler Y, Weissbach A. Persistent pulmonary air leak in the pediatric intensive care unit: Characteristics and outcomes. Pediatr Pulmonol 2021; 56:2729-2735. [PMID: 34048635 DOI: 10.1002/ppul.25509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/24/2021] [Accepted: 05/15/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Persistent air leak (PAL) complicates various lung pathologies in children. The clinical characteristics and outcomes of children hospitalized in the pediatric intensive care unit (PICU) with PAL are not well described. We aimed to elucidate the course of disease among PICU hospitalized children with PAL. METHODS A retrospective cohort study of all PICU-admitted children aged 0-18 years diagnosed with pneumothorax complicated by PAL, between January 2005 and February 2020 was conducted at a tertiary center. PAL was defined as a continuous air leak of more than 48 h. RESULTS PAL complicated the course of 4.8% (38/788) of children hospitalized in the PICU with pneumothorax. Two were excluded due to missing data. Of 36 children included, PAL was secondary to bacterial pneumonia in 56%, acute respiratory distress syndrome (ARDS) in 31%, lung surgery in 11%, and spontaneous pneumothorax in 3%. Compared to non-ARDS causes, children with ARDS required more drains (median, range: 4, 3-11 vs. 2, 1-7; p < .001) and mechanical ventilation (100% vs. 12%; p < .001), and had a higher mortality (64% vs. 0%; p < .001). All children with bacterial pneumonia survived to discharge, with a median air leak duration of 14 days (range 3-72 days). Most of which (90%) were managed conservatively, by continuous chest drainage. CONCLUSION Bacterial pneumonia was the leading cause of PAL in this cohort. PAL secondary to ARDS was associated with a worse outcome. In contrast, non-ARDS PAL was successfully managed conservatively, in most cases.
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Affiliation(s)
- Shelly Kagan
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elhanan Nahum
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Eytan Kaplan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Gili Kadmon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Yulia Gendler
- The Department of Nursing, Ariel University, Ari'el, Israel
| | - Avichai Weissbach
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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8
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Aukes DI, Marco Schnater J, Pijnenburg MW, Kalkman PM, van Capelle CI. Back to the 60s: The Heimlich Valve A patient- and family-centered care perspective. Journal of Pediatric Surgery Case Reports 2021; 70:101887. [DOI: 10.1016/j.epsc.2021.101887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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9
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Abstract
The indications and utility of flexible bronchoscopy have expanded over the past few decades with major innovations in design and development of new tools for endobronchial interventions and image-guided tissue sampling techniques. This review highlights the application of advanced diagnostic bronchoscopy (including endobronchial ultrasound and CT navigational techniques), cryotherapy and the use of one-way endobronchial valves for persistent air leak in the pediatric setting.
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10
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Piñeiro Roncal M, García Luján R, Siesto López GM, Tejedor Ortiz MT, Miguel Poch ED. Use of an Endobronchial Valve for Management of a Persistent Air-leak in a Child with Necrotising Pneumonia. Arch Bronconeumol 2021; 58:S0300-2896(21)00172-1. [PMID: 34158183 DOI: 10.1016/j.arbres.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022]
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Goussard P, Pohunek P, Eber E, Midulla F, Di Mattia G, Merven M, Janson JT. Pediatric bronchoscopy: recent advances and clinical challenges. Expert Rev Respir Med 2021; 15:453-475. [PMID: 33512252 DOI: 10.1080/17476348.2021.1882854] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: During the last 40 years equipment has been improved with smaller instruments and sufficient size working channels. This has ensured that bronchoscopy offers therapeutic and interventional options.Areas covered: We provide a review of recent advances and clinical challenges in pediatric bronchoscopy. This includes single-use bronchoscopes, endobronchial ultrasound, and cryoprobe. Bronchoscopy in persistent preschool wheezing and asthma is included. The indications for interventional bronchoscopy have amplified and included balloon dilatation, endoscopic intubation, the use of airway stents, whole lung lavage, closing of fistulas and air leak, as well as an update on removal of foreign bodies. Others include the use of laser and microdebrider in airway surgery. Experience with bronchoscope during the COVID-19 pandemic has been included in this review. PubMed was searched for articles on pediatric bronchoscopy, including rigid bronchoscopy as well as interventional bronchoscopy with a focus on reviewing literature in the past 5 years.Expert opinion: As the proficiency of pediatric interventional pulmonologists continues to grow more interventions are being performed. There is a scarcity of published evidence in this field. Courses for pediatric interventional bronchoscopy need to be developed. The COVID-19 experience resulted in safer bronchoscopy practice for all involved.
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Affiliation(s)
- P Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - P Pohunek
- Division of Pediatric Respiratory Diseases, Pediatric Department, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - E Eber
- Department of Paediatrics and Adolescent Medicine, Head, Division of Paediatric Pulmonology and Allergology, Medical University of Graz, Graz, Austria
| | - F Midulla
- Department of Maternal Infantile and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - G Di Mattia
- Department of Maternal Infantile and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - M Merven
- Department Otorhinolaryngology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - J T Janson
- Department of Surgical Sciences, Division of Cardio-Thoracic Surgery, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
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Shanthikumar S, Steinfort DP, Ranganathan S. Interventional bronchoscopy in children: Planning the path ahead. Pediatr Pulmonol 2020; 55:288-291. [PMID: 31816189 DOI: 10.1002/ppul.24596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/26/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Shivanthan Shanthikumar
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia
| | - Daniel P Steinfort
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Sarath Ranganathan
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia
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13
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Jaspers GJ, Willemse BWM, Kneyber MCJ. Endobronchial valve placement for a severe pneumothorax in a child on ECLS. Pediatr Pulmonol 2019; 54:1875-1877. [PMID: 31400062 DOI: 10.1002/ppul.24475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/07/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Gerald J Jaspers
- Division of Pediatric Intensive Care, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Brigitte W M Willemse
- Division of Pediatric Pulmonology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin C J Kneyber
- Division of Pediatric Intensive Care, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
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14
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Beckmann N, Luttrell J, Petty B, Rhodes C, Thompson J. Injection bronchoplasty with carboxymethlycellulose with cystoscopy needle for neonatal persistent bronchopleural fistulae. Int J Pediatr Otorhinolaryngol 2019; 127:109651. [PMID: 31470204 DOI: 10.1016/j.ijporl.2019.109651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We describe the novel use of injectable carboxymethylcellulose to close a persistent bronchopleural fistula (BPF) in a neonate who underwent an ex utero intrapartum treatment (EXIT) after aborted fetoscopy. METHODS In this case, a patient with laryngeal atresia underwent fetoscopy that was halted after concern for instruments within the mediastinum, and thus ultimately required an EXIT to establish an airway. Bilateral pneumothoraces and eventually multiple BPF were identified that continued to persist despite multiple attempts at removal of chest tubes over a four-week period. We look at the role of endoscopy and a substance often used in the larynx to help close a persistent BPF. RESULTS At initial bronchoscopy, no BPF was identified, but at subsequent evaluation due to persistent pneumothorax, we used increased positive end expiratory pressure to help reveal the fistula. Given the bronchial location of the fistula, traditional laryngeal instruments could not be used, requiring the use of urologic cystoscopy needles to assist in accessing these challenging locations. At postoperative day 2 from the injection, the chest tube was removed and did not require replacement. CONCLUSION There are many methods to help treat BPF. The endoscopic injection of carboxymethylcellulose adds a technique to the pediatric otolaryngologist's armamentarium.
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Affiliation(s)
- Nicholas Beckmann
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA; LeBonheur Children's Hospital, Memphis, TN, USA.
| | - Jordan Luttrell
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Brad Petty
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA; LeBonheur Children's Hospital, Memphis, TN, USA
| | - Cecil Rhodes
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA; LeBonheur Children's Hospital, Memphis, TN, USA
| | - Jerome Thompson
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA; LeBonheur Children's Hospital, Memphis, TN, USA
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15
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Kuranga AO, Hysinger EB, Caudell Stamper D, Benzaquen S. Filling in the gaps: Implantable bronchial valves in pediatric patients with persistent leaks. Clin Case Rep 2019; 7:2410-2413. [PMID: 31893070 PMCID: PMC6935659 DOI: 10.1002/ccr3.2490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/09/2019] [Accepted: 08/21/2019] [Indexed: 12/30/2022] Open
Abstract
This series presents an adult procedure that benefits young patients with persistent air leaks. This less invasive procedure can be done outpatient with adult/pediatric bronchoscopists providing patients less invasive procedures with better outcomes.
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Affiliation(s)
- Abraham O. Kuranga
- Division of Pulmonary MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhio
| | - Erik B. Hysinger
- Division of Pulmonary MedicineBronchpulmonary Dysplacia Center, Cincinnati Children's Hospital Medical CenterCincinnatiOhio
| | - Danielle Caudell Stamper
- Department of PulmonaryInverventional Pulmonary, University of Cincinnati College of MedicineCincinnatiOhio
| | - Sadia Benzaquen
- Chair of the Division of PulmonaryCritical Care, Allergy and Sleep Medicine at Einstein Healthcare NetworkPhiladelphiaPennsylvania
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16
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Qureshi FG, Abdelrahman A, Baig MZ, Megison S, Abu-hijleh M. Intrabronchial valves for persistent pulmonary air leaks in children. Journal of Pediatric Surgery Case Reports 2019; 45:101201. [DOI: 10.1016/j.epsc.2019.101201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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Criss CN, Barbaro R, Bauman KA, Folafoluwa O, Vellody R, Jarboe MD. Selective Management of Multiple Bronchopleural Fistulae in a Pediatric Patient on Extracorporeal Membrane Oxygenation: A Multidisciplinary Approach. J Laparoendosc Adv Surg Tech A 2018; 28:1271-1274. [PMID: 29920152 DOI: 10.1089/lap.2018.0078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION This case highlights the successful utilization of a multidisciplinary approach to numerous bilateral bronchopleural fistulae (BPF) using minimally invasive techniques. In this study, we present a previously healthy 14-year-old male hospitalized with 2009 H1N1 influenza and methicillin-resistant Staphylococcus aureus coinfection complicated by severe acute respiratory distress syndrome and multifocal necrotizing pneumonia, with significant lung tissue damage requiring prolonged extracorporeal membrane oxygenation (ECMO) support. METHODS The development of multiple BPFs precluded lung recruitment necessary to wean from ECMO. Treatment options were very limited and endobronchial valves were considered. However, localizing single airleaks with a fogarty balloon is normally the technique to determine appropriate location to place the valves. With multiple fistulae, this technique would be ineffective. Therefore, the patient was brought to interventional radiology and bronchography was performed for selective fistula mapping. With this precise localization, the multiple fistulae were ultimately controlled using image-guided embolization and the placement of multiple endobronchial valves. The success of this intervention enabled positive pressure ventilator support and rehabilitation required for weaning from ECMO support. CONCLUSION This case highlights the successful utilization of a multidisciplinary approach to numerous bilateral BPFs using minimally invasive techniques.
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Affiliation(s)
- Cory N Criss
- 1 Section of Pediatric Surgery, Department of Surgery, Michigan Medicine , Ann Arbor, Michigan
| | - Ryan Barbaro
- 2 Division of Pediatric Critical Care Medicine, Department of Pediatrics, Michigan Medicine , Ann Arbor, Michigan
| | - Kristy Ann Bauman
- 3 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan
| | - Odetola Folafoluwa
- 2 Division of Pediatric Critical Care Medicine, Department of Pediatrics, Michigan Medicine , Ann Arbor, Michigan
| | - Ranjith Vellody
- 4 Department of Interventional Radiology, Children's National Health System , Washington, District of Columbia
| | - Marcus D Jarboe
- 1 Section of Pediatric Surgery, Department of Surgery, Michigan Medicine , Ann Arbor, Michigan
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Wilken E, Shaw JA, Koegelenberg CFN. Endobronchial Therapy for Persistent Air Leak. Curr Pulmonol Rep 2018; 7:6-12. [DOI: 10.1007/s13665-018-0195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Alveolar-pleural fistulas causing persistent air leaks (PALs) are associated with prolonged hospital stays and high morbidity. Prior guidelines recommend surgical repair as the gold standard for treatment, albeit it is a solution with limited success. In patients who have recently undergone thoracic surgery or in whom surgery would be contraindicated based on the severity of illness, there has been a lack of treatment options. This review describes a brief history of treatment guidelines for PALs. In the past 20 years, newer and less invasive treatment options have been developed. Aside from supportive care, the literature includes anecdotal successful reports using fibrin sealants, ethanol injection, metal coils, and Watanabe spigots. More recently, larger studies have demonstrated success with chemical pleurodesis, autologous blood patch pleurodesis, and endobronchial valves. This manuscript describes these treatment options in detail, including postprocedural adverse events. Further research, including randomized controlled trials with comparison of these options, are needed, as is long-term follow-up for these interventions.
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Affiliation(s)
- Karen C Dugan
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Balaji Laxmanan
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Septimiu Murgu
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - D Kyle Hogarth
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.
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Webster I, Goussard P, Gie R, Janson J, Rossouw G. The indications and role of paediatric bronchoscopy in a developing country, with high prevalence of pulmonary tuberculosis and HIV. Expert Rev Respir Med 2017; 11:159-165. [PMID: 28107788 DOI: 10.1080/17476348.2017.1280397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Bronchoscopy, an important investigation for the diagnosis and management of respiratory diseases, is widely used in high income countries. There is limited information on value of paediatric bronchoscopy in low and middle income countries (LMIC). AIMS AND OBJECTIVES Aim was to describe the indications, findings and complications of bronchoscopy in a middle income country with a high prevalence of tuberculosis and HIV. METHODOLOGY A retrospective analysis of a database over a 3.5 year period. RESULTS A total of 509 bronchoscopies were performed on neonates (2.3%) and children (median age = 18 months) of which 5.1% were HIV-infected. The main indications were: possible large airway compression 40%, complicated pneumonia (25%) and persistent stridor (15%). Pathology was observed in 64% of bronchoscopies. The most findings were lymph node compression of the airways (21%), and upper airway pathology (12%). Interventional procedures were performed in 112 cases (22%), the commonest being foreign bodies removal (30%), endobronchial lymph node enucleation (30%) and transbronchial needle aspiration (20%). No major complications. CONCLUSION The diagnostic yield of paediatric bronchoscopy did not differ from high income countries emphasising the importance of paediatric bronchoscopy in the management of childhood lung disease in LMICs.
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Affiliation(s)
- Irwin Webster
- a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Children's Hospital , Cape Town , South Africa
| | - Pierre Goussard
- a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Children's Hospital , Cape Town , South Africa
| | - Robert Gie
- a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Children's Hospital , Cape Town , South Africa
| | - Jacques Janson
- b Department of Cardio-Thoracic Surgery, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Children's Hospital , Cape Town , South Africa
| | - Gawie Rossouw
- b Department of Cardio-Thoracic Surgery, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Children's Hospital , Cape Town , South Africa
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Abstract
The objective of this study was to explore the early diagnosis methods of severe pediatric pneumonia. A total of 65 cases hospitalized in pediatric departments and ICU of our hospital because of severe pneumonia were divided into two groups according to pathogen detection. The groups were as follows: 34 cases of bacterial pneumonia, 32 cases of a non-bacterial pneumonia, and 37 cases of healthy children after physical examination in our hospital as the control group. The peripheral blood was sampled from each of the three groups for procalcitonin (PCT). The pediatric PCT level in peripheral blood of the bacterial pneumonia group was significantly higher than that of non-bacterial pneumonia group and the control group. The statistical differences (each at p < 0.01) and the level of pediatric serum PCT in the bacterial pneumonia group before treatment were statistically different from that in the same group after treatment (p < 0.01), while the level of pediatric serum PCT in non-bacterial pneumonia group before treatment was statistical indifferent from that in the same group after treatment (p > 0.01). PCT level in pediatric peripheral blood is an important diagnostic indicator of bacterial infection and a sensitive indicator of distinction between bacterial pneumonia and the non-bacterial pneumonia, thus being of great significance for clinical and differential diagnosis.
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22
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Gilbert CR, Casal RF, Lee HJ, Feller-Kopman D, Frimpong B, Dincer HE, Podgaetz E, Benzaquen S, Majid A, Folch E, Gorden JA, Chenna P, Chen A, Abouzgheib W, Sanny Nonyane BA, Yarmus LB. Use of One-Way Intrabronchial Valves in Air Leak Management After Tube Thoracostomy Drainage. Ann Thorac Surg 2016; 101:1891-6. [PMID: 26876341 DOI: 10.1016/j.athoracsur.2015.10.113] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/29/2015] [Accepted: 10/26/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND A persistent air leak represents significant clinical management problems, potentially affecting morbidity, mortality, and health care costs. In 2008, a unidirectional, intrabronchial valve received humanitarian device exemption for use in managing prolonged air leak after pulmonary resection. Since its introduction, numerous reports exist but no large series describe current utilization or outcomes. Our aim was to report current use of intrabronchial valves for air leaks and review outcome data associated with its utilization. METHODS A multicenter, retrospective review of intrabronchial valve utilization from January 2013 to August 2014 was performed at eight centers. Data regarding demographics, valve utilization, and outcomes were analyzed. RESULTS We identified 112 patients undergoing evaluation for intrabronchial valve placement, with 67% (75 of 112) undergoing valve implantation. Nearly three quarters of patients underwent valve placement for off-label usage (53 of 75). A total of 195 valves were placed in 75 patients (mean 2.6 per patient; range, 1 to 8) with median time to air leak resolution of 16 days (range, 2 to 156). CONCLUSIONS We present the largest, multicenter study of patients undergoing evaluation for intrabronchial valve use for air leak management. Our data suggest the majority of intrabronchial valve placements are occurring for off-label indications. Although the use of intrabronchial valves are a minimally invasive intervention for air leak management, the lack of rigorously designed studies demonstrating efficacy remains concerning. Prospective randomized controlled studies remain warranted.
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Abstract
BACKGROUND Prolonged air leaks may result in increased morbidity and mortality. Endobronchial valves have been used as a nonoperative treatment. We evaluated the efficacy of endobronchial valves at achieving chest tube removal and hospital discharge for air leaks resulting from varied etiologies. METHODS All consecutive patients undergoing endobronchial valve placement for persistent air leak were evaluated by a multidisciplinary team at a single institution. Those receiving valves underwent bronchoscopy with balloon occlusion to identify airways contributing to the leak. After airway sizing, unidirectional endobronchial valves were deployed. RESULTS During an 18-month period, 21 patients underwent 24 valve placement procedures; 88 valves were placed (median, 3; mean, 3.6; range, 1 to 12). Patient age range was 16 months to 70 years. The underlying cause of persistent air leak was postoperative (n = 8), pneumothorax (n = 11), cavitary lung infection (n = 3), and postpneumonectomy bronchopleural fistula (n = 2). There were no valve-related complications during placement, dwell time, or removal. Three patients died as a result of their underlying disease, unrelated to valves. Of those with chest tubes who survived and were discharged, all had successful removal of their chest tubes. Median duration to chest tube removal after initial valve placement was 15 days (mean, 21 days; range, 0 to 86 days). Median length of stay after final valve placement was 5 days (mean, 15 days; range, 0 to 196 days). CONCLUSIONS Challenging air leaks often occur in medically compromised patients. They may persist despite multiple interventions. Endobronchial valves offer minimally invasive management. Time to chest tube removal and length of stay are variable, frequently because of clinical status and underlying disease.
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Affiliation(s)
- Michael F Reed
- Department of Surgery, Division of Thoracic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Christopher R Gilbert
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Matthew D Taylor
- Department of Surgery, Division of Thoracic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jennifer W Toth
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Noah TL, Yilmaz O, Nicolai T, Birnkrant D, Praud JP. Pediatric Pulmonology year in review 2014: Part 1. Pediatr Pulmonol 2015; 50:621-9. [PMID: 25891206 DOI: 10.1002/ppul.23202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/29/2015] [Indexed: 11/08/2022]
Abstract
Our discipline and our journal cover an extremely broad range of research and scholarly topics related to children's respiratory disorders. To better meet the needs of our readership for updated perspectives on the rapidly expanding knowledge in our field, we here summarize the past year's publications in our major topic areas, as well as selected publications in these areas from the core clinical journal literature outside our own pages.
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Affiliation(s)
- Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ozge Yilmaz
- Pediatric Allergy and Pulmonology, Celal Bayar University Department of Pediatrics, Manisa, Turkey
| | | | - David Birnkrant
- MetroHealth Medical Center Department of Pediatrics, Cleveland, Ohio
| | - Jean-Paul Praud
- University Sherbrooke Pediatrics, Sherbrooke, Quebec, Canada
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